微创直接前入路与SuperPATH入路行全髋关节置换术后早期平衡及功能恢复的差异对比

Comparison of the difference between the minimally invasive direct anterior approach and the SuperPATH approach for early balance and functional recovery after total hip arthroplasty

目的 探讨微创直接前入路(DAA)与SuperPATH入路行全髋关节置换术(THA)后早期平衡及功能恢复的差异。方法 2016年8月~2020年8月我院收治的拟行THA的病人82例,依照随机数字表法分为DAA组(微创DAA入路行THA术)和SuperPATH组(SuperPATH入路行THA术),每组各41例。比较两组病人手术相关指标、术后3天髋臼角(前倾角、外展角)。对比两组病人术前(T)、术后1周(T)、术后1个月(T)、术后3个月(T)及术后6个月(T)Berg平衡量表(BBS)评分和髋关节功能Harris评分。比较两组病人术后并发症。结果 SuperPATH组切口长度(6.83±0.72)cm、术中出血量(61.54±10.08)ml、手术时间(125.13±11.27)分钟,DAA组分别为(8.06±0.84)cm、(80.23±15.74)ml、(115.76±10.85)分钟,两组比较差异有统计学意义(P<0.05);两组病人术后引流量分别为(70.25±11.36)ml、(65.87±10.43)ml,差异无统计学意义(P>0.05)。两组病人术后髋臼前倾角分别为(15.72±1.76)°、(15.96±1.85)°,外展角分别为(43.28±3.56)°、(42.75±3.19)°,差异无统计学意义(P>0.05)。BBS评分组间、各时间点、交互对比,差异有统计学意义(P<0.05);T时两组病人BBS评分比较,差异无统计学意义(P>0.05);与T时相比,T、T及T时两组病人BBS评分均降低(P>0.05),且T[(38.25±5.42)vs(34.86±6.08)分]、T时[(41.25±4.96)vs(37.17±4.03)分]SuperPATH组BBS评分高于DAA组(P>0.05);T、T时两组病人BBS评分对比,差异无统计学意义(P>0.05)。髋关节功能Harris评分组间、各时间点、交互对比差异均有统计学意义(P<0.05);T时两组病人髋关节功能Harris评分对比,差异无统计学意义(P>0.05);与T时相比,T、T、T及T时两组病人髋关节功能Harris评分均升高(P>0.05),且T[(66.92±3.87)vs(62.35±3.29)分]、T时[(77.85±4.06)vs(75.02±3.75)分]SuperPATH组髋关节功能Harris评分高于DAA组(P>0.05);T、T时两组病人髋关节功能Harris评分对比,差异无统计学意义(P>0.05)。SuperPATH组、DAA组并发症发生率分别为4.88%、9.76%,差异无统计学意义(P>0.05)。结论 与微创DAA相比,SuperPATH入路行THA术切口长度短、术中出血量少,两种入路行THA术早期平衡及功能恢复均较好,且均安全可靠。

Objective To investigate the difference between the minimally invasive direct anterior approach(DAA) and the SuperPATH approach for early balance and functional recovery after total hip arthroplasty(THA).Methods A total of 82 patients with THA who were admitted to the Eastern Theater General Hospital from August 2016 to August 2020 were divided into DAA group(minimally invasive DAA approach for THA) and SuperPATH group(SuperPATH approach) according to the random number table.THA),41 cases in each group.The acetabular angles(anterior angle, abduction angle) of the two groups of patients were compared with operation-related indicators on the 3 rd postoperative day.Two groups of patients before operation(T),1 week after operation(T),1 month after operation(T),3 months after operation(T) and 6 months after operation(T) Berg Balance Scale(BBS) The score was compared with the Harris score of hip joint function.The postoperative complications of the two groups of patients were compared.Results The length of incision in SuperPATH group [(6.83±0.72) vs(8.06±0.84) cm],intraoperative blood loss [(61.54±10.08)ml vs(80.23±15.74) ml] was shorter(less) than that in DAA group(P<0.05),The operation time [(125.13±11.27)min vs(115.76±10.85) min] was longer than that in the DAA group(P<0.05).The postoperative drainage volume [(70.25±11.36)ml vs(65.87±10.43) ml] of the two groups of patients was compared, and the difference was not statistically significant(P>0.05).The anteversion angle of the acetabulum [(15.72±1.76)° vs(15.96±1.85)°] and the abduction angle [(43.28±3.56)° vs(42.75±3.19)°] were compared between the two groups of patients after surgery, and the difference was not statistically significant(P>0.05).There were statistically significant differences in BBS scores between groups, time, and interaction(P<0.05).There was no significant difference in BBS scores between the two groups at T(P>0.05).Compared with T,the BBS scores of the two groups of patients at T,Tand Twere reduced(P>0.05),and at T[(38.25±5.42)points vs(34.86±6.08) points],Ttime [(41.25±4.96)points vs(37.17±4.03) points],the BBS score of the SuperPATH group was higher than that of the DAA group(P>0.05).There was no significant difference in BBS scores between the two groups at Tand T(P>0.05).There were statistically significant differences in the Harris scores of hip joint function between groups, time, and interaction(P<0.05).There was no significant difference in Harris scores of hip joint function between the two groups at T(P>0.05).Compared with T,the Harris scores of hip joint function of the two groups of patients at T,T,T,and Tincreased(P>0.05),and T[(66.92±3.87)minutes vs(62.35±3.29) minutes],T[(77.85±4.06)points vs(75.02±3.75) points] The Harris score of hip joint function in SuperPATH group was higher than that in DAA group(P>0.05).There was no significant difference in Harris scores of hip joint function between the two groups at Tand T(P>0.05).The incidence of complications in the SuperPATH group and DAA group were 4.88% and 9.76%,respectively, and the difference was not statistically significant(P>0.05).Conclusion Compared with minimally invasive DAA,the SuperPATH approach for THA has a shorter incision length and less intraoperative blood loss.The two approaches for THA have better early balance and functional recovery, and both are safe and reliable.